Ebola Virus Is Spreading by Harlan R. Sonderling, Aaron Reames and Walter Colsman, ColumbiaManagement
- The Ebola outbreak is the largest and most serious outbreak ever of this highly-contagious viral disease.
- Despite the scary headlines, the virus seems unlikely to spread inside the U.S. or other parts of the developed world.
- The focus remains on treating Ebola victims, containing the spread of the virus in Africa and preventing its intercontinental transmission.
The Ebola outbreak in March in the West African countries of Sierra Leone, Guinea, Liberia and Nigeria is the largest and most serious outbreak ever of this highly-contagious viral disease, and its first appearance outside sub-Saharan Africa. The disease originates with animal carriers and infects human beings and other primates. It is transmitted among humans by contact with an infected victim’s bodily fluids or contaminated personal items. There are no documented cases of airborne transmission, though there is concern that the virus could mutate. Ebola infects blood vessels and causes massive internal bleeding and organ failure. The disease has a 2- to 21-day incubation period, and it is believed to be contagious only after the first symptoms appear, which reduces risk of broad and rapid transmission. Initial symptoms are similar to those of other diseases of the developing world, complicating diagnosis.
Health systems in the part of Africa where the disease has reappeared are understaffed and function poorly. Hospital-acquired transmission has occurred due to the lack of protective supplies and too few medical precautions such as sterilizing equipment and protective gloves, gowns, masks and goggles. Nigeria’s swift response has so far succeeded in halting that nation’s Ebola infection. There is no specific treatment for the disease; treatment is largely supportive, including pain management, medications for nausea and fever and fluids intravenously or orally.
Ebola is unlike contagious airborne viral diseases like influenza, swine flu, avian flu or SARS (severe acute respiratory syndrome, a pneumonia-like disease), all of which attack the body’s respiratory systems and were deemed pandemics. Malaria, another viral disease occurring mostly in Africa, is both preventable and treatable, leading to its far lower mortality rate. There are no vaccines to prevent Ebola nor drugs to treat it, though a number of experimental treatments are under expedited investigation. In August, the World Health Organization stated that the use experimental preventives and treatments is ethical in certain situations. Among existing drugs being tested are monoclonal antibody vaccines, existing influenza drugs and vaccines and estrogen-receptor drugs used to treat breast cancer and infertility. The most promising developmental drugs rely on RNA interference to slow or eliminate viral replication. The most promising vaccines are derivatives of existing viral vaccines. The current diagnostic test takes hours, if not days, but faster and more reliable diagnostic tests are under development and will be critical tools for containing the disease. Bear in mind, however, that Africa would be the destination for the vast majority of these drugs, almost all of which would be provided on a humanitarian basis. As well, the cost of producing some of these drug candidates at pilot scale is prohibitive.
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The first appearance of Ebola in the United States last week in an individual who traveled by air from Liberia raises concern of transmission beyond Africa. This individual is said not to have exhibited symptoms prior to his flight and is now in hospital quarantine. Individuals with whom he had primary or secondary contact are in home quarantine. While the virus seems unlikely to spread inside the U.S. or other parts of the developed world, efforts to prevent contagion, as well as unfounded fears, will likely lead to higher sales of infection preventive equipment such as gloves, masks and gowns. Such precautions may also depress airline and other travel-related volumes. Hospital and hydration and other drug volumes are unlikely to be affected unless there is a sizeable outbreak of the disease. Deranged global terrorists may seek to infect themselves with Ebola and travel to the developed world to attempt to introduce and spread the disease and accompanying fear, which could depress economic and commercial activity. It is not impossible that the disease could be weaponized in airborne form, not unlike anthrax, for which the U.S. government has stockpiled treatment. For now, however, the focus remains on treating Ebola victims, containing the spread of the virus in Africa, and preventing its intercontinental transmission. We hope and pray for the unfortunate victims, their families and their nations.